Discouraged

[codergal]

Had my appointment with my internist yesterday and he is very happy (as well as I) that my readings have improved - a.m. average 119 - evenings still a little high - I am on Humulin 70/30 - 70 in a.m. - 40 before supper and also Lantus at bedtime. However I gained 8 lbs in a month!!!!! I have been trying to stay on low carb (it is very hard at times) - but I know to get stricter -

Would love to hear from any of you who are on insulin and how your weight losses have been - my doc also said that if I lost weight, I could possibly get off insulin - well, if I was not on insulin, I could lose weight -

Sorry for rambling - just discouraged.

[MizKitty]

I lost all my weight while taking insulin, I just stopped the insulin a couple months ago.

But no where near as much as you're taking. I was just on 17 units of Lantus.

Insulin is a fat-storage hormone as I'm sure you are aware, but if you don't eat the carbs, there's nothing for it to store.

So you must re-dedicate yourself to eating VLC. ( Another thing I'm sure you are aware :) ) Keep them down to 30 net a day or less, consistently, ala Dr. Bernstein, and I bet you will soon be off all but the long acting.

Have you looked into Levemir instead of Lantus? I've heard that it does not have the weight-gain side effect the way Lantus does.

[Korban]

Would love to hear from any of you who are on insulin and how your weight losses have been - my doc also said that if I lost weight, I could possibly get off insulin - well, if I was not on insulin, I could lose weight -

Sorry for rambling - just discouraged.

Congratulations on your improved BG numbers.

It does sound a classic "double bind" which it is... Everything I read though says that BG control is much more important than losing the weight. Once BG's are under control, one's focus can then shift more to the weight issue - but not at the expense of BG control.

For me, the only way I could get BG under control was to restrict carbs, and I usually still do 20 - 30 grams per day. Others here can eat much more than that. I can't seem to successfully yet.

Also in my limited experience, once my BG was controlled, I found I had more energy and began to exercise - YMMV. A reasonable (healthy) loss regime means one or two pounds per week and some people suggest weighing only once per week at the same time, since weight can fluctuate several pounds during the course of the day anyway. This suggestion is not cast in stone but I find it less depressing this way... :)

The weight has slowly but surely come down and I do not seem hungry even though my caloric intake is only 1200 - 1400 kcals per day. Since I do not eat many carbs, I do eat much more fat (saturated and mono-unsaturated, especially) and that seems to satiate me more than refined carbs ever did. For other dietary needs I try to keep my protein at the lower end of suggestion (1.0 - 1.2 g protein per kg of lean body mass). The lower end of protein (1.0) will assist in weight loss as well.

I still have a long way to go but in no big hurry - gaining weight was a long process; I don't think it unreasonable that losing weight is too.

I wish you the best,
/smile

[Lottadata]

You should talk to your doctor about getting off the 70/30 and using a basal insulin--humalog or novolog instead. The 70/30 is a mixture of slow and fast insulin which makes it VERY tough to match your insulin to your carb intake. You end up hungry because you have too much insulin. So you eat.

Get Dr. Bernstein's Diabetes Solution book and read it carefully and you'll have a better idea of how to use insulin with a low carb diet.

When your insulin is matched to your carbs just right, you won't be hungry you can get MUCH better blood sugar control and then it is much easier to lose.

[codergal]

Thank all of you for your input and I will definitely get my Dr. Bernstein book out tonight and read it again.

Once again thank you and I appreciate these forums for the support -
good luck to all of you on your low carb journey.

[dancinbr]

Yes get off of the 70/30.

That simply doesn't make sense at all.

You must go low carb to lose weight.

If you can follow Dr. B's advice you will 6-12-12.

I need to practice what I preach as well.

I am taking Levemir 50 in am and 27 in PM.

I use Novolog to cover my carbs by taking it before each meal.

I usually keep my carbs below 60 ranging from 30-60.

Lately, I have gained some weight but it is all about controlling carbs. I took a holiday and enjoyed some carb treats. I also learned a lot about controlling my BG as well. My 7 day average is now 95 and heading down, my 14 day average is 99 and my 30 day average is 105. So it is coming down.

Also, by finding the right AM, PM doses of basal insulin and keeping your carbs low or as close to 6-12-12 as possible you will see your morning dawn phenomena disappear.

I also correct any reading in the morning with Novolog to get it down to 80.

For example, this morning I was 110. I used Novolog to get it down to 80.

I am staying in the 70s and 80s most of the time now and I know how much Novolog to use to cover my carb intake at each meal.

The theory of small numbers is so important. When you get down to the 6-12-12 you need very little Novolog to offset the carbs and if you are starting a meal with a BG reading around 83 you easily can emulate a normal BG curve and keep your peaks under 120 after one hours and then see a good reading under 100 after two hours.

This takes some experience to really get good at this but don't discourage.

Also, be careful about BG crashes. I have learned that if I exercise my BG will drop quite a bit. When playing 9 holes of golf (walking and pulling cart all the way ) my BG went from 91 down to 45 and that was after I had a sandwich that included about 20 carbs. So I know now to consume carbs while playing golf to keep my BG from crashing.

All this comes with your own experience and becoming aware of HOW YOU react to your insulin, your Novolog etc.

For example, I found I need 1 unit of Novolog to offset 5 carbs of intake, BUT THIS IS DIFFERENT FOR EACH OF US. I am obese. You are still heavy. We are taking "industrial" doses of insulin as Dr. B would suggest. Our reward some day is to reduce our insulin needs to minimal or off of them completely. But this does require that the weight comes off.

To get the weight off you must definitely follow 6-12-12 or even as Atkins would suggest an induction mode under 20 if I recall correctly and then finding what carb intake you can sustain and still lose weight. I couldn't go much above 40 and still lose weight. At 60 I don't lose weight and if I sustain a carb intake above 60 each day I gain weight.

Best wishes to you,

Ralph

And smile, you will learn and beat this. :D

[janeff]

Hi Ralph,I read your response and wonder if you know anyone following Dr. Bernstein (Diabetes Solution) who is or has been on an insulin pump?
As I continue with the lo carb approach,I am having the devil of a time managing the basal rates with the insulin pump....sometimes very low,sometimes too high.
Any words about this and yes,those of encouragement would be welcome too?
Jane

[RobLL]

While I do not use a pump, and Dr. Berstein is not a real fan, a pump really should make it easier to control basal. You need to find how much insulin at various times of day, and I understand that pumps can be set to a low dosage, and then up it at the right time in the morning to deal with DP. It is your job to figure out by testing where these higher doses need to be determined and cranked in to your pump. Within pretty broad limits there is no real worry about mistakes (you don't want going below 60, say, and brief excursions even to 180 as you are learning are not going to be serious) - so it can be become a kind of game, like Crossword Puzzles or Sudoku. I started by trying to stay between 100 and 120. Over time I have got it down to 80-100. This morning I was 60, a really unexpected, but not dangerous low for me. So more tinkering, I do not want to go below 70. Going low carb and hence lower amounts of insulin helps you stay in or close to pre-determined limits. Because of the immediate danger of extreme lows, the first rule is "Don't get Lows". Because of the long term dangers of highs (but not short term), the rule for me is to keep chipping away at whatever your current highs are. One might start by never going above 200, then after you get that figured out, never above 180, and so on, until you get down to whatever is you or your doctor's goal. Good Luck

[Lottadata]

Janeff,

There are several people using insulin pumps who post on Dr. Bernstein's forum. Just google for it and you'll find it.

They are Type 1s getting spectacular A1cs so if you go over there they can probably help you readjust your basal rate, etc, so that you aren't having the problem with lows.

Let us know here what you learn!

[Korban]

Janeff,

There are several people using insulin pumps who post on Dr. Bernstein's forum. Just google for it and you'll find it.

http://www.diabetes-book.com/cgi-bin/yabb2/YaBB.pl

[Lottadata]

http://www.diabetes-book.com/cgi-bin/yabb2/YaBB.pl

Korban,

Glad you posted the link. I wasn't sure what the policy was on this board for posting links. Some moderators have been known to get really nasty if you post about another board. Glad that isn't the case here!

Hope your son is recovering well!

[dancinbr]

Hi Ralph,I read your response and wonder if you know anyone following Dr. Bernstein (Diabetes Solution) who is or has been on an insulin pump?
As I continue with the lo carb approach,I am having the devil of a time managing the basal rates with the insulin pump....sometimes very low,sometimes too high.
Any words about this and yes,those of encouragement would be welcome too?
Jane

I have a friend on an insulin pump.

She is very careful with what she eats, but she doesn't follow Dr. B.

She has carbs and focuses on low fat.

She has read parts of Dr. B's book, but hasn't made the leap.

I don't know if she could help you out at all since she doesn't necessarily believe in the 6-12-12 low carb diet, which normally carries with it high fat.

She believes fat causes jumps in her BG, which is so wrong from everything that I have read.

Sorry.

Ralph

[dancinbr]

Whoops!

I see that both Korban and Jenny have posted some very useful information.

good luck,

Ralph

[eddiemcm]

It appears that there is a delicate balancing between insulin
and carb intake to avoid highs and lows.It's probably difficult
to manage at first.Bernstein has some great information on
that subject in his book.
Cheers
Eddie

[Lottadata]

I have just this week finally found an insulin regimen that makes it possible to eat very low carb again. I did it for years without insulin, but I never could get my blood sugars down to normal --the best I could do was the 110s fasting and eventually that took a toll on my remaining beta cells.

I'm currently using a tiny dose of Levemir twice a day, even an additional 1/4 unit will mess it up, though! But for the first time in my whole life I am in the 80s most of the time, even after meals, which is pretty astounding.

The insulin I'm using is a sample the doctor gave me that is near its expiration date, and hence weakened. That really helped. If I get the new stuff I'm going to have to drop the dose even further.

[RobLL]

I have just this week finally found an insulin regimen that makes it possible to eat very low carb again. I did it for years without insulin, but I never could get my blood sugars down to normal --the best I could do was the 110s fasting and eventually that took a toll on my remaining beta cells.

I'm currently using a tiny dose of Levemir twice a day, even an additional 1/4 unit will mess it up, though! But for the first time in my whole life I am in the 80s most of the time, even after meals, which is pretty astounding.

The insulin I'm using is a sample the doctor gave me that is near its expiration date, and hence weakened. That really helped. If I get the new stuff I'm going to have to drop the dose even further.


Will you have to dilute it, in order to control doses? The real pain on that is finding a pharmacy that has the dilutant and empty bottles.

[Lottadata]

RobLL,

I don't know. The first time I tried Levermir, I used 2 units and saw a dramatic drop in my fasting blood sugar even after eating some carbs, but my blood pressure surged! No one had any idea why, including my endo and the manufacturer who made me send them back my Levemir after I called to inquire about it.

I'd been using 3 units a day of Lantus but also getting blood pressure problems after a few weeks, so 2 units of Levemire seemed like a low dose at the time.

But recently I found I was doing better with lantus split 1/1 but I was still getting fasting bgs in the mid 90s, and I started gaining weight.

But now I'm using only 1.25 morning and .75- unit at night of the weakened Levemir and getting the great results. So I guess the BP rise was from using too much and getting a counterregulatory response.

I have two pens of the old samples which will last until it goes bad. I made a few novolog pens last for several months, so I hope I can do this with these. I keep them in the fridge.

After they're gone, I'll see if the doctor has any more--she told me none of her patients are interestd in trying Levemir, which is why she had the samples left. If not, I'll buy a new vial and start out with a 1/2 unit dose and see what happens.

It's really odd that I am that sensitive to the basal insulin, because my insulin/carb ratio at meals when I'm not taking metformin is about 1/10-12. Not all that sensitive.